Arthur Caplan, Ph.D.
Among the greatest failures in American public health—and the list is a long one—is the rise in the incidence of cervical cancer. Incredibly, cancers caused by human papillomavirus rose in the past decade. From 2000 to 2009 rates of oral, vulva and anal cancers increased, according to a recent study by the National Cancer Institute. What makes this grim fact a notable public health failure is that we have not one but two vaccines that can greatly diminish these cancers. Both Merck and GSK market HPV vaccines–Gardasil and Cervarix. Gardisal has been around since 2006. So given the preventive power of the vaccines, why the upward trend in cancer?
“The investments we have made in HPV research to establish these relationships and to develop effective and safe vaccines against HPV will have the expected payoffs only if vaccination rates for girls and boys improve markedly,” says NCI Director Harold Varmus. What he is saying is that way too few women and men are getting vaccinated.
Barely a third of girls ages 13 to 17 had been vaccinated as of 2010 which is way far below the 80% rate needed to significantly reduce the prevalence of cancer causing viral infections. Vaccination rates among boys who can spread the virus are much lower.
Few cancers are preventable with a vaccine. Two that work pretty well against a nasty form of cancer are around. Why aren’t they getting used? The answer is a mix of ease of use, fear-mongering and moral failure.
The HPV vaccine requires three shots. No one likes shots so that is a challenge. Bringing your kid to the doctor three times is also a hassle. Reminding kids to come in for their second and third shot is more work for busy primary care doctors and their staffs. And the shots are not cheap, running over $400, a cost not always covered by insurance.
HPV vaccination got bogged down in a moral quagmire. The companies making the shots aggressively promoted them raising suspicions of profiteering. Attempts to impose mandates in order to attend school foundered because they looked to many like industry conspiracies to make a buck.
Many religious conservatives argued against vaccination in favor of abstinence — a strategy clearly not working in any way at all. And some challenged the safety of the vaccine, including Michelle Bachmann during her thankfully brief Presidential run, even though the track record for both vaccines is one of amazingly few adverse events—fainting being the primary and very rare problem.
America is wealthy enough to vaccinate its kids against cervical and other cancers. Government should be pushing to get the best price and then get those in risk groups all three shots. Ethically a rise in HPV caused cancer among young Americans is moral failure leading to a public health failure that is inexcusable.